Senior Analyst, Provider Relations MAPL Focus (Metro NY)
Core
Support provider-facing operations by analyzing claims data, resolving operational escalations, and ensuring accurate claims processing for health systems.
Role type
Senior Analyst, Provider Relations
Builds
Operational stability and accurate claims resolution for provider partners
Domain
Healthcare operations / Claims administration
Deliverable
dashboards & analysis
Required skills
Claims analysis, Medical terminology, Microsoft Office Suite, Root cause analysis, Contract compliance, Data interpretation
Preferred skills
Physician engagement, Claims operations experience, Enrollment processes knowledge
Responsibilities
Conduct detailed claims and spreadsheet analysis to identify issues and trends; Manage intake and resolution of operational requests (NEF/SNOW tickets); Escalate system and data issues to partners for resolution; Participate in Joint Operating Committee discussions and claims escalation calls; Educate providers on claims policies and plan design; Partner with contracting teams to address operational concerns; Perform claim reviews for disputes and settlement support; Triage member and provider issues to appropriate teams; Perform root cause analysis on recurring provider issues; Ensure adherence to contract terms and regulatory requirements; Engage directly with key providers to support service levels.
